Treatment Failure: Just Another Puzzle Piece

Every health professional is destined to spend a certain amount of time reviewing someone else’s work. When a patient has sought help elsewhere before coming to my clinic, conversation in the exam room often revolves around a laundry list of the previous doctor’s shortcomings along with a running tally of money spent on the condition. Neither of those topicsis a productive use of our time, but that stack of paperwork generated by the previous clinic can be a treasure trove of information.

By and large, patients visit a second clinic for one reason only, and that is the persistence of their illness. The problem was not resolved. It is absolutely vital that the records from the first doctor be provided when seeking a second opinion. A second doctor may be able to make meaningful progress—if equipped with the details of punches thrown in the previous bout. At its most basic, this is a list of treatments that need not be repeated; however, it should also be reviewed for any subtle adjustments in dosage, duration, route of administration, and the like that could improve the outcome. Don’t ever seek a second opinion with the words “the other doctor tried EVERYTHING” unless you are prepared for a lengthy (and perhaps very tedious) conversation. If your previous clinic already tried EVERYTHING, then it will probably take me a long time to pinpoint the things they didn’t try… and then try them.

Failed treatments aren’t actually a waste of your money. On the contrary, these events are used to help rule out certain illnesses that had been under consideration. See, there isn’t a test for every condition in pet animals. Sometimes there is a test, but it’s too risky to perform on your pet or so expensive that most people can’t afford it. Or both of those things. Sometimes there is a test, but it isn’t very trustworthy, despite all of the efforts that have been made to perfect it. In these cases, a therapeutic trial is needed. Yes, we send home a treatment... and see what happens. Perhaps that sounds more like a craps table than a doctor’s office, but I assure you it is meticulously calculated. Therapeutic trials are selected based on the cost of the medicine and its safety profile, its reliability against the suspected condition, and the length of time it might take to observe a successful outcome.Sometimes your veterinarian will even deliberately opt for a “treatment failure” to be sure that every avenue of approach to your pet’s illness has been explored. If this approach is the winner, then everyone is surprised and pleased. Handshakes all around and a couple of high fives. If not, then another piece of information is added to the dossier.

A long list of unsuccessful therapies is depressing for you, but it doesn’t mean that the doctor who compiled it is a knucklehead. Rather, that person has revealed their tenacity and dedication to helping your pet. Using that list of treatment failures as a road map, we may find that a solution to your problem is right around the corner.

Dr. M.S. Regan